Lyme disease in Oregon

[cave76]

Permission to repost granted by the site http://kaiserpapers.org/

http://lyme.kaiserpapers.org/oregon.html

"Lyme Disease in Oregon

Oregon ranks as one of the worst states in the nation to get help for Lyme disease. Over one-fourth of the state’s population is enrolled in HMO’s and standards of care seem to be determined by these entities, Kaiser in particular, and their financial influence on the state’s medical university, Oregon Health Sciences University (OHSU). The Oregon Board of Medical Examiners, which includes two members who are not even doctors or in any way involved in medicine, appears to be compliant to their wishes."

Washington (the state) isn't any better.

[JackieCalifornia]

Truly said.

Hey, here's an idea!  Let's let the Feds take over medical care!  Then we can get a physical every time go through an airport 'security' checkpoint ... or at least a grope.

Sigh.  

[Ricobord]

Wow. That's really disturbing. I imagine those rules were designed to break through the white wall of silence that stood for so long, where doctors were very reluctant to report another doctor's incompetence until massive jury verdicts for negligence started getting attention.

It's definitely Gestapo-like to use a rule like this to persecute doctors who prescribe antibiotics for a sick patient.  It could be interpreted to mean that a doctor should report any doctor who treats any patient beyond how they themselves would treat a patient.  It will drive treatment down to the lowest common denominator and most restrictive and cautious treatment.  

Doctors will no longer do anything unless they're positive about a diagnosis.  The IDSA actively encourages this. They tell doctors not to treat Lyme or Babesia without positive lab tests, regardless of symptoms. The only exception is for an erythema migrans.  Even though they know some patients test false negative, they just pretend as if those patients don't exist.

It all comes down to the fact that doctors don't get penalized or found responsible for any harm that comes to a patient when they follow the "standard of care."  It is better for the doctor's livelihood to literally let you suffer rather than give you antibiotics.  

And it's only getting worse. Government and Medicare officials are already discussing new standards of care in order to cut down on costs.  I am fine with limiting heroic and costly efforts for me if I am elderly and my mind is gone from Alzheimer's.  It's a waste to spend a quarter million dollars on someone at the end of their life, just to give them a couple more weeks or months. Especially when younger people who can be restored to productivity go without treatment.

But I fear we'll become like Britain, where a local committee sifts through applications for Gastric Bypass surgery, choosing a few of the worst patients to get it, as that's all the funding they have. Of course the worst 10% of patients are least likely to recover any meaningful function, as compared to the ones with a strong chance of recovery and going back to work.  

Government rules rarely do a good job of rationing anything, let along encouraging good judgement.  Just look at how detailed the TSA rules have become in order to prevent the stupid application of some of them, such as telling a nursing mother that she has to throw out all the breast milk she pumped, even though it's in 3 oz containers in the regulation zippered baggie. (The reason given was that she didn't actually have the baby with her.)  No way can any organization keep up with the hugely complex and fast changing field of medicine, and yet I'm sure it won't stop them from trying.

[JackieCalifornia]

.... stated more succinctly:

Absence of evidence is not evidence of absence.  

[JackieCalifornia]

I don't think we've got any firm data on prevalence in any particular location, because far too many of those who publish the statistics have preconceived notions of where Lyme is and isn't, and the diagnostic criteria are not accurate except for those of organizations like ILADS.

If (as I suspect) the statisticians are using data based on IDSA-type standards, then there is massive undercounting of disease prevalence.  I don't think it's got anything to do with population density, since the vectors (carriers) of Lyme are not solely humans -- it's ticks and animals, which are everywhere, regardless of human population in a particular area.

So yes, I think the 'low' numbers in Oregon are likely because of low recognition, not low prevalence.

[cave76]

Not only can't they get dx'd in OR but doctors are told as close to point-blank as can be------if you know of another doctor who is treating Lyme "outside of standard practices" you're required to report them. If not....... possible sanctions will be handed down to you also. (Standard practice means CDC Elisa-crap, or 10-30 days doxy if you have a bulls-eye rash.)

Prohibited conduct = treat/test for Lyme disease.
David Gilbert at OS

Doesn't that sound like the Gestaspo to you??? (A little flight of fancy there).

Here is the part of the Oregon legislature regarding physicians.
http://www.leg.state.or.us/ors/676.html  

"Duty to report prohibited or unprofessional conduct, arrests and convictions; investigation; confidentiality; immunity from liability.

(5) A licensee who fails to report prohibited or unprofessional conduct as required by subsection (2) of this section or the licensee’s conviction or arrest as required by subsection (3) of this section is subject to discipline by the board responsible for the licensee.
(6) A licensee who fails to report prohibited conduct as required by subsection (2) of this section commits a Class A violation."
*********************************************
On second thought that DOES seem like the Gestapo. Rat on your cohorts and avoid a penalty.

[Ricobord]

I am still mystified by Kaiser and other HMOs who are so rigid about diagnosing and treating Lyme Disease.  Surely it costs them more to treat people with ongoing late stage infections than it does to get them well.  I wouldn't want to be a doctor or a patient in an HMO dealing with emerging and/or poorly understood diseases.  There's no room to go outside the official cookbook for treating patients.

While Lyme is present all over the West, including Central and Southern California, it's more prevalent along the coast, especially from the Santa Cruz Mountains in CA all the way up to the Northeast corner of Seattle.  (I'm sure the ticks continue up into Canada... I'm just referring to the U.S. here.)  

I've heard so little about Oregon and Lyme, I just thought that perhaps Lyme wasn't that common there because the population along the coast isn't that high.  Maybe it's because very few of the victims of it ever get diagnosed. :(

[mojogal]

That is very sad. Reminds me of Texas.

[JackieCalifornia]

Sigh.  Think how much productive time is wasted by ignoring all those who have tickborne illness!